Cioffi Camille C, Acevedo Ann Martinez, Cohen Deborah J, Kaufman Menolly R, Parker Kea, Terplan Mishka, Lindner Stephan R
Oregon Research Institute, Springfield, OR, USA.
Prevention Science Institute, University of Oregon, Eugene, OR, USA.
Addiction. 2025 May;120(5):997-1006. doi: 10.1111/add.16752. Epub 2025 Jan 10.
Medication is the gold standard to support a healthy pregnancy for pregnant people with opioid use disorder (OUD). This study measured inequities and differences in OUD medication treatment among pregnant people in Oregon, USA.
DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Our study population consisted of Medicaid enrollees across the US state of Oregon who had at least one live hospital birth between 2012 and 2020 and one diagnosis of OUD prenatally (n = 4363). We measured differences in demographic characteristics (age, race, ethnicity, location) among those with and without medication for OUD in the prenatal through 3-months postpartum period (any medication use, and by type), and compared exclusive methadone versus buprenorphine receipt. We report unadjusted and adjusted odds ratios.
Adjusted odds ratios for medication for OUD were lower among American Indian/Alaska Native pregnant people compared with White pregnant people [adjusted odds ratio (aOR) 0.59 (95% confidence interval [CI] = 0.42, 0.83)], younger pregnant people compared with those aged 30-34 years [aOR, ages 15-19: 0.1 (95 CI = 0.06, 0.18); aOR, ages 20-24: 0.58 (95 CI = 0.49, 0.69)] and rural pregnant people compared with those in urban communities [aOR 0.58 (95 CI = 0.5-0.67)]. Rural pregnant people with OUD also had lower odds of methadone receipt [aOR 0.23 (95 CI = 0.17, 0.3)] and higher odds of buprenorphine receipt [aOR 3.99 (95 CI = 2.97, 5.35)] than other people in this study. Among those who received medication, Black pregnant people had increased odds of receiving methadone compared with buprenorphine [aOR 2.09 (95 CI = 1.1-3.97)].
In Oregon, USA, inequities in receipt of any medication for opioid use disorder were observed among pregnant people who identified as American Indian or Alaska Native, younger than 25, and living in rural communities. Black pregnant people in Oregon, USA, were more likely to receive methadone than buprenorphine.
药物治疗是支持患有阿片类物质使用障碍（OUD）的孕妇实现健康妊娠的金标准。本研究衡量了美国俄勒冈州孕妇在OUD药物治疗方面的不公平现象和差异。
设计、地点、参与者与测量方法：我们的研究人群包括美国俄勒冈州医疗补助计划的参保者，他们在2012年至2020年期间至少有一次在医院的活产记录，并且产前被诊断为OUD（n = 4363）。我们测量了产前至产后3个月期间接受和未接受OUD药物治疗的人群在人口统计学特征（年龄、种族、族裔、地点）方面的差异（任何药物使用情况，以及按类型划分），并比较了单纯接受美沙酮与丁丙诺啡治疗的情况。我们报告了未调整和调整后的比值比。
与白人孕妇相比，美国印第安/阿拉斯加原住民孕妇接受OUD药物治疗的调整后比值比更低[调整后比值比（aOR）为0.59（95%置信区间[CI] = 0.42, 0.83）]；与30 - 34岁的孕妇相比，年龄较小的孕妇接受治疗的调整后比值比更低[aOR，15 - 19岁：0.1（95% CI = 0.06, 0.18）；aOR，20 - 24岁：0.58（95% CI = 0.49, 0.69）]；与城市社区的孕妇相比，农村孕妇接受治疗的调整后比值比更低[aOR 0.58（95% CI = 0.5 - 0.67）]。患有OUD的农村孕妇接受美沙酮治疗的几率也低于本研究中的其他人群[aOR 0.23（95% CI = 0.17, 0.3）]，而接受丁丙诺啡治疗的几率高于其他人群[aOR 3.99（95% CI = 2.97, 5.35）]。在接受药物治疗的人群中，与接受丁丙诺啡相比，黑人孕妇接受美沙酮治疗的几率更高[aOR 2.09（95% CI = 1.1 - 3.97）]。
在美国俄勒冈州，自我认定为美国印第安人或阿拉斯加原住民、年龄小于25岁且居住在农村社区的孕妇在接受阿片类物质使用障碍药物治疗方面存在不公平现象。在美国俄勒冈州，黑人孕妇接受美沙酮治疗的可能性高于丁丙诺啡。
